Effectiveness of Peyton’s Four Step Approach (PFSA) versus traditional method on skill acquisition, self-efficacy and satisfaction among undergraduate nursing students at a selected college in Udupi district, Karnataka- A Randomized Control Trial

Teaching methods influence students’ competence, self-efficacy, and satisfaction. Traditionally, clinical skill training has followed the demonstration-redemonstration model, where the students learn the skill by observing the tutors, but this method has shown notable limitations in promoting skill retention and building confidence among learners. To overcome these challenges, structured and learner-centered models like Peyton’s Four-Step Approach (PFSA) are being explored.

Peyton’s Four-Step Approach is a four step method of skill training consisting of: (1) Demonstration where the trainer performs the entire procedure without commentary, (2) Deconstruction where the trainer again performs the entire procedure with explanation, (3) Comprehension where the learner guides the teacher through the steps, and (4) Performance where the learner executes the procedure independently.

This parallel group Randomized Controlled Trial will be conducted among the students studying in 2nd semester BSc Nursing in Manipal College of Nursing, Manipal Academy of Higher Education, Karnataka. The required sample of students will be selected randomly using a computer-generated random number generator from the entire batch of 2nd semester BSc Nursing (2025-2026 batch). The selected students will be randomly allocated into two groups (Intervention group and Control group). The study will take place in the Fundamentals of Nursing Laboratory (A & B) of the college. The control group students will be taught using the demonstration-re-demonstration method, which is the standard teaching method used for skill training in the college, where, the teacher will demonstrate and explain the procedures for assessing the cardiac and respiratory systems while the student observes.

For the Intervention Group, the skills will be taught using PFSA, which includes the following 4 steps:

Step 1: Demonstration: The instructor will perform the entire skill of cardiac assessment and respiratory assessment at a normal pace without commentary. The students will only observe.

Step 2: Deconstruction: Instructor will repeat the skill but explain each step in detail, breaking it into parts (e.g., patient preparation, position, etc.). In this step, students may ask questions.

Step 3: Comprehension: The instructor repeats the skill with the guidance of the students, as they verbally direct each step of the procedure.

Step 4: Performance: The student carries out the skill on their own, while describing the steps. After the Implementation of the training, the students will be assessed for their skill acquisition immediately after the training using the OSCE checklists by the trainers. After 2 weeks, skill acquisition will be reassessed through a structured OSCE by the primary investigator, using the same OSCE checklists. Students’ satisfaction with the training method will be evaluated after two weeks using a self-structured Student Satisfaction Level Scale, while their self-efficacy will be assessed using the Learning Self-Efficacy Scale (L-SES).

Data will be analyzed using descriptive and inferential statistics using Jamovi software.